Dr Manny's Notes

Ugly toenails? It might be fungus

Manny Alvarez

Odds are pretty good that you’ll have the pleasure of fighting off toe nail fungus at some point in your life. Ten percent of adults have it, but the statistics jump to 20 percent and 50 percent of adults over 60 and 70, respectively. You might even have it now and be unaware of it, especially if you swim in public pools or if your feet sweat inside your shoes for hours a day.

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The technical term for nail fungus is onychomycosis, and it usually starts out as a white or yellow spot under the nail, not something most people would pay much attention to. The nail begins to thicken, and by the time a toenail is thick, discolored, and crumbling at the edges, it’s clear that something is out-of-sorts, and you’re looking at full-blown case of nail fungus that may take years to get rid of.

The fungus that causes the problem can be the same one that causes athlete’s foot, and the two conditions can occur at once if the fungus also affects the skin around the infected nail. You may find that your toes are a little bit painful or notice a foul odor. Some people go straight to their doctor while others try self-care first.

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There are a number of ways you can try to treat toe fungus at home, including over-the-counter antifungal creams. If you have athlete’s foot, you’ll need to treat that too with a separate over-the-counter cream or spray. Believe it or not, the use of a cheap, over-the-counter cough therapy has also been studied for use in treating toenail fungus. A study found that Vicks VapoRub had a positive effect for 83 percent of people, and completely cleared 27.8 percent of cases at the end of 48 weeks. These results may not seem impressive unless you’re familiar with just how tenacious toenail fungus can be.

There are no medications that can guarantee a complete and fast cure for toenail fungus, but there are a few potent prescription anti-fungals that show good results. Terbinafine and itraconazole are usually only taken for 6 to 12 weeks, but it can take four months or longer to see complete improvement. The downside to these treatments is that there can be side effects that range from annoying (skin rashes and stomach problems) to dangerous (liver damage and heart problems). Frequent blood tests are used to monitor patients’ health when they’re taking these medications. Medicated nail polish or medicated nail creams may also be prescribed. These medications take longer to clear the infection, but they also have fewer side effects.

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A relatively new treatment for toenail fungus involves the use of laser technology. More research needs to be done, but some laser treatments show promise for being safe and effective against toenail fungus. It’s common to need multiple laser treatments, but side effects are mild compared to other options and include swelling and reddening of the skin. The biggest downside to laser therapy is that it’s expensive and usually not covered by insurance.

In extreme cases, toenail fungus is treated by removing the entire nail. The new nail will take a year or more to grow in, and this time can be difficult for patients. Sometimes the nail bed is also treated with an antifungal to ensure that the new nail is not infected. Risks of this minor surgery include pain, infection, and abnormal growth of the new nail. Though this is often effective, even nail removal doesn’t have a 100 percent cure rate, and some patients have the procedure more than once.

If you suspect you may have toenail fungus, try to start treatment as early as possible. Always consult with your doctor is you have questions about changes to your toenails. It’s especially important that you keep a close lookout for toenail fungus is you have diabetes (which can affect circulation to the feet) or a suppressed immune system. Toenail fungus can cause more serious complications for these people.

This article first appeared on AskDrManny.com.

Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny's work, visit AskDrManny.com.